Silent Feto-Maternal Bleed as a Cause of Severe Neonatal Anemia

Abstract

Feto-maternal bleed is a common presentation during pregnancy that may have adverse consequences on the perinatal clinical course of the infant and mother alike. Anemia is a common presentation of an infant secondary to feto-maternal bleed. Large volume feto-maternal bleeds may lead to severe neonatal anemia in the absence of obvious maternal symptoms. Hence, a high index of suspicion must be maintained in the absence of other obvious causes of neonatal anemia. We describe a case of an infant with severe anemia secondary to a silent feto-maternal bleed associated with a normal appearing placenta on examination and the absence of obvious maternal symptoms.sepsis. Transcutaneous bilirubin was measured at 0.8 mg/dl and later a serum bilirubin showed an unconjugated bilirubin of 0.5 mg/dl and conjugated bilirubin of 0.0 mg/dl. On physical exam, baby had a normal anterior fontanelle without any signs of bulging and a soft non-distended, non-tender abdomen with normal bowel sounds. 20 ml/kg of packed red blood cells was emergently transfused. Blood was transfused over 4 hours in 2 aliquots without any complications. CBC post transfusion showed a Hgb of 10.9 g/dl and a Hct of 31.6%, The heart murmur was no longer audible post transfusion. The baby continued to be hemodynamically stable post transfusion. Hemoglobin electrophoresis was sent and it returned normal results. Further maternal history and an additional bedside test revealed the diagnosis.